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Friday, July 23, 2010

Who Spends $15,000 A Year on Medicine? I DO!

Yesterday, APL went to pick up my Enbrel and some other prescriptions on his lunch hour, because he is the sweetest ever! But when he got there, the pharmacy charged him $750 for the Enbrel. Yes, you read that right, $750. That one prescription cost more than our monthly car payment and HOA fees combined. It's enough for me to buy an amazing wedding dress or, apparently, get stabbed 4 times by a needle. I just spent three hours on the phone with various insurance agents trying to figure out why the Enbrel was suddenly so expensive.

I mean, didn't I already pay for health insurance? I did. And my plan from Aetna should cover 50% of my prescriptions. However, it only covers up to $5,000 per policy year on prescriptions. Apparently I have already reached that cap. So the health insurance is no help.

But aren't there support programs to help pay for expensive drugs like Enbrel? There are. The Enbrel Support Program offers 6 months of Enbrel at no cost and then $10 or less out-of-pocket per month thereafter. Until you hit their cap of $4,000 per six months. Which I have already hit. Twice.

So: I now have zero prescription coverage until school starts again. And not just for Enbrel, but for all of the other 459 prescriptions I take every day. (Ok, ok. More like seven. But still!!) I'll have to pay full price for all of them.

Including Enbrel. And, believe it or not, the $750 APL paid yesterday was after what was left of my support had already been applied. Which means that next time I go to pick up Enbrel, they'll charge $1,600. Awesome.

You know what else this means? I hit a $5,000 cap and two $4,000 caps and I have paid hundreds of dollars of co-payments to the pharmacy myself. This means that I have spent more than $10,000 on medicine in less than a year!! In fact, the total is closer to $15,000. You could by an entire car for that amount. Or a whole wedding. HOW DO DRUGS POSSIBLY COST THAT MUCH?!?!

SKYE: I talked to the folks at Enbrel support (http://www.enbrel.com/pay-for-ENBREL.jspx) and they are running some kind of check on my insurance to see what kind of help they can potentially offer me. I also know someone who gets her Enbrel through the ENcourage foundation: http://wwwext.amgen.com/citizenship/encourage_foundation.html so I may look there next if the support doesn't come up with anything.

That sucks! I reached my limit with Enbrel too. I thought it wasn't helping that much, so my rheumatologist had me get off it to see. But just in case I was wrong, I found a few things that would help. The National Psoriasis Foundation has a list of copay assistance plans (that help more than just those with psoriasis or PsA): https://www.psoriasis.org/NetCommunity/SSLPage.aspx?pid=1368Hope you find some way to not pay that crazy amount every month.

I have been resistant to taking any of the "newer" drugs due to the fact I would like to have a life outside of RA/LUPUS that doesn't include a bankruptcy, going hungry or robbing stores. I think it is utterly ridiculous that ANY med on this planet cost so much to aid others in health care. Can you imagine, humans die because they can't afford this crap we shove in our bodies to feel better even if only for an hour. When they come without harsh side effects, it might be worth it. But now, I don't know.

I realize i'm no help to you in this post but this pisses me off that folks like you want to try to feel better and you get screwed by big medicine/insurance. Frustrating as all get out to me.

TAZZY: Yes, going hungry and robbing stores (thought I was thinking banks...) is generally a bad idea. ~;o) Unfortunately, it's this medicine that has helped me get at least a little closer to feeling like my old self again. ::sigh::

But I want you to know that it IS helpful to me to know that there are others out there who understand my frustration!! Every comment on this blog helps!